National Health Insurance: Here are the real facts


National Health Insurance: Here are the real facts
National Health Insurance: Here are the real facts

Following President Cyril Ramaphosa’s comments in parliament with which he painted a rosy picture of the national health insurance (NHI), AfriForum gives the real facts on this bill that will have far-reaching consequences for South Africans. It is a comprehensive bill that aims to completely communise the healthcare industry in the country. In effect, it would mean that the government will have the power to decide what treatment you need, who should provide it and where you should obtain it.

The bill can still be opposed.
The bill was recently tabled in Parliament by Dr Zweli Mkhize, Minister of Health. This is the first step to proclaim the bill law. A portfolio committee will then be appointed, after which the public will be able to comment on the bill. It is important that as many people as possible object to the implementation of this bill. Civil rights organisations, such as AfriForum, play an important role in this regard.

You will have to be a member of the NHI.
South Africans will have no other choice but to be members of the NHI. Moreover, taxpayers will be required to pay for NHI, even if they choose to make contributions to a private medical scheme. To qualify for fund cover, citizens will have to register with an accredited healthcare provider or institution. New-born children will automatically be registered on the fund.

Contribution will be pooled in a central fund.
All health income generated by the NHI will be paid into a central fund from which payments will be made. The NHI envisages a national, single-paying health system for South Africa that will dictate service levels, price and the extent of care.

Taxpayers will have to foot the bill.
About 8,3% of the population will be forced to fund the NHI on behalf of the whole country. According to the South African Revenue Service (SARS), there were only 4,8 million taxpayers in the 2018 financial year, while South Africa’s population stood at 57,7 million at the time.

The government will have access to your medical information.
The fund may use your medical information for any legitimate purpose applicable to the functions of the fund. Healthcare providers will also be free to share this information with one another in the interest of members. The fund also aims to set up and maintain a national data base based on the population’s demographic and epidemiological profile.

You will have to register with a certain healthcare provider.
The bill determines that fund members must obtain healthcare from the primary healthcare provider with whom they are registered. This could mean that you will have to register with a certain house doctor. The number of visits you are entitled to may also be limited. The fund and the Minister of Health will also have the power to decide the minimum range of personal healthcare services.

If you break the rules, you won’t be covered.
Fund members will be compelled to first obtain healthcare services on a primary healthcare level. If you want to have further healthcare service – for example access to a specialist – you will have to follow the prescribed reference routes. If you do not, you are not entitled to fund benefits. Moreover, you will have direct access to specialists such as oncologists and gynaecologists.

A range of medical service, treatment and procedures will be covered.
These services will be free without co-payments. The fund will not cover the treatment, however, if it isn’t medically necessary and where there won’t be a cost-effective intervention. If the fund refuses to pay for a procedure, you may appeal, but no timeframe is linked to this process – the bill only prescribes a “reasonable time”.

The government will determine what medical services would cost.
The government will annually determine prices for specific services. These prices will then determine what healthcare providers will be paid.

Medical scheme will most probably disappear.
As soon as the NHI is fully implemented, medical schemes will only be able to cover additional cover. In other words: If the specific healthcare service is covered by the NHI, your medical scheme may not also cover it. The increased tax to fund the NHI will most probably make medical schemes unaffordable for the middle class.

The government will buy medicine for everyone.
The government will provide medicine to all NHI members.

The government will decide which doctors may offer their services under the NHI.
There will be a strict contract between the fund and accredited healthcare providers or institutions. This agreement will determine how many patients they’d be able to see and how many services they may render. Sanction will be instituted against healthcare providers who violate the agreement, and accreditation will be revised every five years.

Foreigners will not be covered.
Foreign visitors will have to take out travel insurance to obtain medical services from the fund. Illegal immigrants and asylum seekers will only qualify for care in emergencies, but their children will be entitled to basic healthcare services.

“Even if government paints it as the goose that lays the golden eggs, the NHI is not the answer to South Africa’s healthcare problems. Luckily, it can still be stopped. South Africans should oppose this system with all their might and give AfriForum their mandate to protect the free market principles,” says Natasha Venter, Campaigns Officer at AfriForum.

Help AfriForum to oppose the NVG here

Read the original article in Afrikaans on AfriForum

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